Download University of Jaffna MBBS 2014 November Pathology Paper II Question Paper

UNIVERSITY OF JAFFNA, SRI LANKA

SECOND EXAMINATION FOR MEDICAL DEGREES—PARTII (2nd)-

NOVEMBER 2014-

PATHOLOGY-Paper II

Date: 05.11.2014.

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Time: 03 hours

ANSWER ALL 10 QUESTIONS

Answer each question in separate answer book

1. 1.1 A 50 year old female presented with excessive weight gain in spite of decreased appetite. Clinical diagnosis of hypothyroidism was made.

   1. 1.1.1 List two investigations that would confirm the diagnosis and mention the changes that you would expect in the investigations in primary and secondary hypothyroidism. (20Marks)

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   2. 1.1.2 List three causes of hypothyroidism. (10Marks)

   3. 1.1.3 List the clinical manifestations of hypothyroidism in relation to

      1. 1.1.3.1. Cardiovascular system. (10Marks)
      2. 1.1.3.2_Central nervous system (10 Marks)

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   1.2 1.2.1 List two causes for each of the following conditions.

   1. 1.2.1.1.Hypocortisolism (10Marks)
   2. 1.2.1.2.Hypercortisolism (10Marks)

   1.2,2. Describe the biochemical investigations you would carryout to confirm the diagnosis mentioned in 1.2.1.1, 1.2.1.2 (30Marks)

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2. A 55 year old presented with tiredness and was found to have a Hb of 8 01. A haemolytic anaemia was suspected.

   1. 2.1. Briefly describe the classification of haemolytic anaemia. (25 Marks)
   2. 2,2. List 2 clinical findings that you would expect to see in a patient with haemolytic anaemia. (10Marks)
   3. 2.3. List 3 investigations that you expect to be abnormal in a patient with a haemolytic anaemia. List the expected abnormality for each investigation that you mention. (15 Marks)
   4. 2.4. Describe the pathogenesis of 2 of the laboratory abnormalities that you mention in (2,3) (20Marks)

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   5. 2,5. List 2 complications that a patient with haemolytic anaemia may have. (20Marks)
   6. 2.6. State one medication that is usually prescribed for patients with haemolytic anaemia. (10 Marks)

3. 3. 3.1 A 60 year old man presented with progressive dyspnea and cough for 1 year duration. The chest Xray showed hyperinflated lungs with reduced vascular markings.

   1. 3.1.1, What is the most probable diagnosis? (5marks)

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   2. 3.1.2. Discuss the pathogenesis of the above process. (25Marks)
   3. 3.1.3. Describe the pathological feature of the above condition. (20 Marks)

   3.2 A 35 year old male patient presented with sever persistent cough with expectoration of mucopurulent sputum. Chest x-ray revealed a cavitating lesion of the lungs with surrounding consolidation. He is diagnosed as having bronchiectasis.

   1. 3.2.1, List two other differential diagnoses for the above mentioned radiographic appearance. (10Marks)
   2. 3.2.2. Describe the microscopic appearance of one of the conditioned mentioned above (20Marks)

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   3. 3.2.3. List 3 predisposing factors for bronchiectasis and explain the pathological mechanism for each. (20Marks)

4. Mention two etiologies / risk factors and pathological changes (rnacroscopy and microscopy) that may occur in the following conditions.

   1. 4.1 A 60 year old female presented with lump in the left breast and crusting exudate over the nipple and areolar skin. (35Marks)
   2. 4.2 A 58 year old male presented with ulcer in glans penis. (30 Marks)

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   3. 4.3 A 75 year old male presented with urinary out flow obstruction, haematuria and back pain .Digital rectal examination revealed irregular palpable nodules (35 Marks)
5. 1. 5.1 Define a polyp. (10 Marks)
   2. 5.2 List 4 types of polyps that occur in the colon. (40Marks)
   3. 5.3 Describe the microscopy of one of the polyps mentioned in (5.2). (30 Marks)

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   4. 5.4 List 2 features that determine the malignant potential of a polyp in the colon. (20Marks)
6. 1. 6.1 Define an infarct. (10 Marks)
   2. 6.2 List four (4) causes for vascular occlusion (20Marks)
   3. 6.3 Describe one of the causes mentioned in 6.2. (30 Marks)

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   4. 6.4 Briefly describe four factors that determine effects of arterial obstruction. (40 Marks)

7. A 60 year lady presented with symptoms of gradually progressive anaemia. Based on the clinical findings and baseline investigations a provisional diagnosis of megaloblastic anaemia was made.

   1. 7.1. Briefly describe the biochemical basis for megaloblastic anaemia due to vitamin B 12 and folate deficiency (30Marks)
   2. 7.2 List the abnormalityies you can observe in the blood film of a patient with megaloblastic anaemia (15Marks)

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   3. 7.3 Briefly describe the abnormalities you can observe in the bone marrow aspirate film of a patient with megaloblastic anaemia (15Marks)
   4. 7.4 Mention the neurological manifestations of vitamin B 12 and folate deficiency (20 Marks)
   5. 7.5 List the causes of vitamin B12 deficiency (20Marks)

8. A 60 year old previously hypertensive man died of intracranial haemorrhage. An autopsy was performed.

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   1. 8.1 Briefly describe the expected autopsy (macroscopic) findings of the ( 75Marks) brain of this patient.
   2. 8.2 Briefly describe the aetiopathogenesis and pathological features of (25 Marks) cerebral abscess
9. 1. 9.1 Briefly describe the pathogenesis of glomerular injury in glomerulonephritis. (50 Marks)
   2. 9.2 Describe the pathological (macroscopic and microscopic) findings of the kidneys in malignant hypertension. (25 Marks)

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   3. 9.3 Briefly describe the pathological features of diabetic nephropathy. (25Marks)

10. 10

    10.1 A 30 year old male patient admitted to surgical causality ward with right leg cellulitis for last two days.

    1. 10.1.1. What are the cardinal signs he to confirm the diagnosis? (10Marks)

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    2. 10.1.2. Explain the pathological basis of these cardinal signs. (50Marks)

    10.2 The above patient developed abscess in the right leg on the fourth day after admission

    1. 10.2.1. What is an abscess? (15Marks)
    2. 10.2.2. Explain the pathological basis of the treatment of abscess. (25Marks)

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